Preoperative computed tomography-guided localization for pulmonary nodules: a systematic review and meta-analysis of soft hook-wire and coil localization

Abstract

Background: Preoperative computed tomography (CT)-guided analysis of pulmonary nodule (PN) localization is performed to increase the success of resection surgery using video-assisted thoracoscopic surgery (VATS). This meta-analysis compared the relative efficacy and safety of soft hook-wire (SHW) and coil-based strategies for CT-guided PN localization.

Methods: The databases of PubMed, Wanfang, and Cochrane Library were searched to acquire relevant studies published before September 2024 using the following search query: (((coil) AND ((((localization needle) OR (anchored needle)) OR (Sens-cure needle)) OR (soft hook-wire))) AND (localization)) AND ((lung nodule) OR (pulmonary nodule)). The acquired related outcomes were pooled and analyzed.

Results: This meta-analysis included 8 studies, including 440 patients undergoing CT-guided coil localization for 502 PNs and 446 patients undergoing CT-guided SHW localization for 521 PNs. The results indicated that the SHW and coil groups had similar pooled localization success rates (P=0.13), pulmonary hemorrhage rates (P=0.28), limited resection duration (P=0.91), pneumothorax rates (P=0.18), and entire VATS duration (P=0.07). Furthermore, SHW localization analysis was substantially faster than coil localization analysis (P=0.0009). Moreover, there was significant heterogeneity in the endpoints of localization duration (I²=95%) and limited resection duration (I²=76%). In addition, there was no publication bias in any endpoints.

Conclusions: This study indicated that both coil- and SHW-based CT-guided PN localization can inform limited resection using VATS with similar safety and success rates. However, compared to coil localization, SHW localization is time saving.

Keywords: Coil; computed tomography (CT); localization; pulmonary nodule (PN); soft hook-wire (SHW).

Figure 1

The flow chart of this study.

Figure 2

Pooled results for (A) successful CT-guided localization rates, (B) the localization time, (C) pneumothorax rates, (D) pulmonary hemorrhage rates, (E) limited resection time, and (F) entire VATS time in the coil and SHW groups. CI, confidence interval; CT, computed tomography; IV, inverse variance; M-H, Mantel-Haenszel; SD, standard deviation; SHW, soft hook-wire; VATS, video-assisted thoracoscopic surgery.